Hospital admissions in the final weeks

Planned vs emergency admissions

In the final weeks of a terminal illness, hospital admissions generally fall into two categories: planned admissions for specific purposes (symptom stabilisation, a procedure, a palliative care bed) and emergency admissions when something changes suddenly.

Planned admissions can be discussed and prepared for. If a hospital admission is recommended for any purpose, ask: what is the goal of this admission, how long is it expected to be, will it achieve what we want, and what is the plan for returning home or transitioning to another care setting?

Emergency admissions are harder to plan for, but having a reliable after-hours contact with the palliative care team can make a real difference. People who are linked in early with community palliative care tend to need emergency departments less in their final months. See the in-home care guide for more on after-hours support.

What to bring for a hospital admission

For any planned hospital admission, prepare a bag in advance. Include: a current medication list (names, doses, and frequencies), a copy of any Advance Care Directive, contact details for the treating specialist and palliative care team, personal items that provide comfort (photographs, a music player with headphones, familiar clothing), toiletries, charging cables, and a small amount of cash.

Keep the medication list current and easily accessible. Update it whenever medications change. This list will be asked for at every hospital admission.

Communicating with hospital staff

In a hospital admission during the final weeks of a terminal illness, ensure the treating team at the hospital knows the full context: the diagnosis, the current palliative care team, the Advance Care Directive, and the person's expressed wishes about the goal of admission.

Hospital staff change every shift. Important information about wishes and care plans can be lost between shifts. Ask for this information to be clearly documented in the hospital notes, and repeat it to each new treating team at the start of their care.

If you feel the hospital team is not aligned with the person's wishes or the care plan, ask to speak with the treating doctor directly. If this does not resolve the issue, ask for the hospital's palliative care team to be consulted, or contact the hospital's patient liaison officer.

The Advance Care Directive in hospital

The Advance Care Directive is the most important document you can have with you in a hospital setting. It tells the treating team what the person does and does not want in terms of medical intervention, including resuscitation, artificial ventilation, and artificial feeding. The name differs between states and territories, for example an advance health directive in Queensland and Western Australia, but the purpose is the same.

Bring a physical copy to every hospital admission. Ask the admitting nurse to include it in the medical record. Ask specifically: "Has the Advance Care Directive been noted in the chart?" Do not assume it has been seen just because you handed it over.

If there is no Advance Care Directive, the treating team will look to any medical order already in place (such as a resuscitation plan or goals of care form, whose name varies by state) and to the person's substitute decision maker, who is worked out under state law. Without the person's wishes written down, decisions can take longer and may not reflect what they wanted. This is another reason why completing an Advance Care Directive while there is still time matters so much.

Visitor management

Hospital admissions during the final weeks may attract significant family and visitor interest. This can be exhausting for the person who is unwell. Consider designating one family member as the contact person who communicates updates to others, rather than having the person who is sick receive multiple phone calls and visits each day.

It is entirely legitimate to ask the nursing staff to limit visitors, to direct visitors to call ahead, or to request that the person not be disturbed during rest periods. Staff will usually help.

For close family and partners, ask the nursing staff about flexible visiting hours. Many wards, palliative care wards especially, will try to accommodate family members who want to stay overnight or be present around the clock as death approaches.

Discharge planning

From the moment of admission, ask about the discharge plan. What needs to happen before discharge is safe? Who needs to be involved in arranging care at home? What equipment and services will be needed? When is discharge expected?

Discharge from hospital in the final weeks sometimes happens more quickly than families expect. It is worth being proactive about ensuring home services are in place before the person returns home, rather than discovering after discharge that the support is not organised.

Ask for the hospital social worker to be involved in discharge planning. They can coordinate with community palliative care, My Aged Care, and other services to ensure a safe return home. My Aged Care is the starting point for arranging home care, nursing, and equipment for people aged 65 and over after a hospital stay.